Healthcare Provider Details

I. General information

NPI: 1659655421
Provider Name (Legal Business Name): ERIKA WONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 07/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 N LAKE AVE SUITE 108A
PASADENA CA
91104-5818
US

IV. Provider business mailing address

1028 N LAKE AVE SUITE 108A
PASADENA CA
91104-5818
US

V. Phone/Fax

Practice location:
  • Phone: 800-488-3414
  • Fax: 866-488-8170
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW33765
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: